Benefit Limitations. This benefit has one or more exclusions as specified in the Exclusions Section. You have the option to purchase up to a 90-day supply of Prescription Drugs/Medications. Under the up to a 90-day at Retail Pharmacy benefit, Preferred Generic, Non-Preferred Generic, Preferred Brand and Non-Preferred Drugs can be obtained from an In-network Pharmacy. If you choose the 90 days at retail option, you will be charged one Copayment per 30-day supply up to a maximum of a 90-day supply. Some medications may qualify for third-party copayment assistance programs which could lower your out-of-pocket costs for those products. For any such medication where third-party copayment assistance is used (Discount Cards or Prescription Drug Savings Cards), the Member shall not receive credit towards their maximum out-of-pocket or deductible for any copayment or coinsurance amounts that are applied to a manufacturer coupon or rebate. Self-Administered Specialty Pharmaceuticals Self-Administered Specialty Pharmaceuticals are self-administered, meaning they are administered by the patient, a family member or caregiver. Specialty Pharmaceuticals are often used to treat complex chronic, rare diseases and/or life-threatening conditions. Most Specialty Pharmaceuticals require Prior Authorization and must be obtained through the specialty pharmacy network. Specialty Pharmaceuticals are often high cost, typically greater than $600 for up to a 30-day supply. · Specialty Pharmaceuticals are not available through the retail or mail order option and are limited to a 30-day supply. Certain Specialty Pharmaceuticals may have additional day supply limitations. · Most Specialty Pharmaceuticals must be obtained through the Specialty Pharmaceutical network. For a complete list of these drugs, please see the Specialty Pharmaceutical listing at xxxx://xxxx.xxx.xxx/idc/groups/public/documents/communication/pel_00000000.pdf. You can call our Presbyterian Customer Service Center, Monday through Friday, from 7 a.m. to 6 p.m. at (000) 000-0000 or 0-000-000-0000. Hearing impaired users may call TTY 711.
Appears in 1 contract
Samples: Subscriber Agreement
Benefit Limitations. This benefit has one or more exclusions as specified in the Exclusions Section. You have the option to purchase up to a 90-day supply of Prescription Drugs/Medications. Under the up to a 90-day at Retail Pharmacy benefit, Preferred Generic, Non-Preferred Generic, Preferred Brand and Non-Preferred Drugs can be obtained from an In-network Pharmacy. If you choose chose the 90 days at retail option, you will be charged one Copayment on copayment per 30-day supply up to a maximum of a 90-day supply. Some medications may qualify for third-party copayment assistance programs which could lower your out-of-pocket costs for those products. For any such medication where third-party copayment assistance is used (Discount Cards or Prescription Drug Savings Cards), the Member shall not receive credit towards toward their maximum out-of-pocket or deductible for any copayment or coinsurance amounts that are applied to a manufacturer coupon or rebate. Self-Administered Specialty Pharmaceuticals Pharmaceuticals Self-Administered Specialty Pharmaceuticals are self-administered, meaning they are administered by the patient, a family member or caregivercare-giver. Specialty Pharmaceuticals are often used to treat complex chronic, rare diseases and/or life-threatening conditions. Most Specialty Pharmaceuticals require Prior Authorization and must be obtained through the specialty pharmacy network. Specialty Pharmaceuticals are often high cost, typically greater than $600 for up to a 30-day supply. · Specialty Pharmaceuticals are not available through the retail or mail order option and are limited to a 30-day supply. Certain Specialty Pharmaceuticals may have additional day supply limitations. · Most Specialty Pharmaceuticals must be obtained through the Specialty Pharmaceutical network. For a complete list of these drugs, please see the Specialty Pharmaceutical listing at xxxx://xxxx.xxx.xxx/idc/groups/public/documents/communication/pel_00000000.pdf. You can call our Presbyterian Customer Service Center, Monday through Friday, Friday from 7 a.m. to 6 p.m. at (000) 000-0000 or 0-000-000-0000. Hearing impaired users may call TTY 711. A Medical Drug is any drug administered by a Healthcare Professional and is typically given in the member's home, physician’s office, freestanding (ambulatory) infusion suite, or outpatient facility. Medical Drugs may require a Prior Authorization and some must be obtained through the specialty network. These drugs may be subject to a separate Copayment/Coinsurance to a maximum as outlined in your Summary of Benefits and Coverage.
Appears in 1 contract
Samples: Subscriber Agreement
Benefit Limitations. This benefit has one or more exclusions as specified in the Exclusions Section. You have the option to purchase up to a 90-day supply of Prescription Drugs/Medications. Under the up to a 90-day at Retail Pharmacy benefit, Preferred Generic, Non-Preferred Generic, Preferred Brand and Non-Preferred Drugs can be obtained from an In-network Pharmacy. If you choose the 90 90-days at retail option, you will be charged one Copayment per 30-day supply up to a maximum of a 90-day supply. You will be charged three applicable Copayments for up to a 90-day supply up to the maximum dosing recommended by the manufacturer/FDA. Some medications may qualify for third-party copayment assistance programs which could lower your out-of-pocket costs for those products. For any such medication where third-party copayment assistance is used (Discount Cards or Prescription Drug Savings Cards), the Member shall not receive credit towards their maximum out-of-pocket or deductible for any copayment or coinsurance amounts that are applied to a manufacturer coupon or rebate. Self-Administered Specialty Pharmaceuticals Pharmaceuticals Self-Administered Specialty Pharmaceuticals are self-administered, meaning they are administered by the patient, a family member or caregiver. Specialty Pharmaceuticals are often used to treat complex chronic, rare diseases and/or life-life- threatening conditions. Most Specialty Pharmaceuticals require Prior Authorization and must be obtained through the specialty pharmacy network. Specialty Pharmaceuticals are often high costcosts, typically greater than $600 for up to a 30-day supply. · Specialty Pharmaceuticals are not available through the retail or mail order option and are limited to a 30-day supply. Certain Specialty Pharmaceuticals may have additional are limited to an initial fill up to a 15-day supply limitations. · Most Specialty Pharmaceuticals must be obtained through to ensure patients can tolerate the Specialty Pharmaceutical networknew medication. For a complete list of these drugs, please see the Specialty Pharmaceutical listing at xxxx://xxxx.xxx.xxx/idc/groups/public/documents/communication/pel_00000000.pdf. You can call contact our Presbyterian Customer Service Center, Monday through Friday, from 7 a.m. to 6 p.m. Center at (000) 000-0000 or 0-000-000-0000. , Monday through Friday from 7 a.m. to 6 p.m. Hearing impaired users may call TTY 711.
Appears in 1 contract
Samples: Subscriber Agreement
Benefit Limitations. This benefit has one or more exclusions as specified in the Exclusions Section. You have the option to purchase up to a 90-day supply of Prescription Drugs/Medications. Under the up to a 90-day at Retail Pharmacy benefit, Preferred Generic, Non-Preferred Generic, Preferred Brand and Non-Preferred Drugs can be obtained from an In-network Pharmacy. If you choose the 90 days at retail option, you will be charged one Copayment copayment per 30-day supply up to a maximum of a 90-day supply. Some medications may qualify for third-party copayment assistance programs which could lower your out-of-pocket costs for those products. For any such medication where third-party copayment assistance is used (Discount Cards or Prescription Drug Savings Cards), the Member shall not will receive credit towards their maximum out-of-pocket or deductible for any copayment or coinsurance amounts that are applied to a manufacturer coupon or rebate. Self-Administered Specialty Pharmaceuticals Self-Administered Specialty Pharmaceuticals are self-administered, meaning they are administered by the patient, a family member or caregivercare-giver. Specialty Pharmaceuticals are often used to treat complex chronic, rare diseases and/or life-life- threatening conditions. Most Specialty Pharmaceuticals require Prior Authorization and must be obtained through the specialty pharmacy network. Specialty Pharmaceuticals are often high cost, typically greater than $600 for up to a 30-day supply. · Specialty Pharmaceuticals are not available through the retail or mail order option and are limited to a 30-day supply. Certain Specialty Pharmaceuticals may have additional day supply limitations. · Most Specialty Pharmaceuticals must be obtained through the Specialty Pharmaceutical specialty pharmacy network. For a complete list of these drugsdrugs and formulary coverage, please see the Specialty Pharmaceutical listing at xxxx://xxxx.xxx.xxx/idc/groups/public/documents/communication/pel_00000000.pdfxxxx://xxxx.xxx.xxx/idc/groups/public/documents/communication/pel_00236101.pdf. For Specialty Pharmacy information please see the pharmacy services available at xxxxx://xxx.xxx.xxx/doctors-services/services-centers/supporting- services/Pages/pharmacy-services.aspx. You can call our Presbyterian Customer Service CenterCenter for additional information about the Presbyterian Specialty Pharmacy network, Monday through Friday, Friday from 7 a.m. to 6 p.m. at (000) 000-0000 or 0-000-000-0000. Hearing impaired users may call TTY 711.
Appears in 1 contract
Samples: Subscriber Agreement
Benefit Limitations. This benefit has one or more exclusions as specified in the Exclusions Section. You have the option to purchase up to a 90-day supply of Prescription Drugs/Medications. Under the up to a 90-day at Retail Pharmacy benefit, Preferred Generic, Non-Preferred Generic, Preferred Brand and Non-Preferred Drugs can be obtained from an In-network Pharmacy. If you choose the 90 90-days at retail option, you will be charged one Copayment copayment per 30-day supply up to a maximum of a 90-day supply. You will be charged three applicable Copayments for up to a 90-day supply up to the maximum dosing recommended by the manufacturer/FDA. Some medications may qualify for third-party copayment assistance programs which could lower your out-of-pocket costs for those products. For any such medication where third-party copayment assistance is used (Discount Cards or Prescription Drug Savings Cards), the Member shall not receive credit towards their maximum out-of-pocket or deductible for any copayment or coinsurance amounts that are applied to a manufacturer coupon or rebate. Self-Administered Specialty Pharmaceuticals Self-Administered Specialty Pharmaceuticals are self-administered, meaning they are administered by the patient, a family member or caregiver. Specialty Pharmaceuticals are often used to treat complex chronic, rare diseases and/or life-threatening conditions. Most Specialty Pharmaceuticals require Prior Authorization and must be obtained through the specialty pharmacy network. Specialty Pharmaceuticals are often high cost, typically greater than $600 for up to a 30-day supply. · Specialty Pharmaceuticals are not available through the retail or mail order option and are limited to a 30-day supply. Certain Specialty Pharmaceuticals may have additional are limited to an initial fill up to a 14-day supply limitations. · Most Specialty Pharmaceuticals must be obtained through to ensure patients can tolerate the Specialty Pharmaceutical networknew medication. For a complete list of these drugs, please see the Specialty Pharmaceutical listing at xxxx://xxxx.xxx.xxx/idc/groups/public/documents/communication/pel_00000000.pdfxxxx://xxxx.xxx.xxx/idc/groups/public/documents/communication/pel_00000000. pdf. You can call contact our Presbyterian Customer Service Center, Monday through Friday, from 7 a.m. to 6 p.m. Center at (000) 000-0000 or 0-000-000-0000. , Monday through Friday from 7 a.m. to 6 p.m. Hearing impaired users may call our TTY line at 711.
Appears in 1 contract
Samples: Group Subscriber Agreement
Benefit Limitations. This benefit has one or more exclusions as specified in the Exclusions Section. You have the option to purchase up to a 90-day supply of Prescription Drugs/Medications. Under the up to a 90-day at Retail Pharmacy benefit, Preferred Generic, Non-Preferred Generic, Preferred Brand and Non-Preferred Drugs can be obtained from an In-network Pharmacy. If you choose the 90 days at retail option, you will be charged one Copayment per 30-day supply up to a maximum of a 90-day supply. Some medications may qualify for third-party copayment assistance programs which could lower your out-of-pocket costs for those products. For any such medication where third-party copayment assistance is used (Discount Cards or Prescription Drug Savings Cards), the Member shall not receive credit towards their maximum out-of-pocket or deductible for any copayment or coinsurance amounts that are applied to a manufacturer coupon or rebate. Self-Administered Specialty Pharmaceuticals Self-Administered Specialty Pharmaceuticals are self-administered, meaning they are administered by the patient, a family member or caregiver. Specialty Pharmaceuticals are often used to treat complex chronic, rare diseases and/or life-life- threatening conditions. Most Specialty Pharmaceuticals require Prior Authorization and must be obtained through the specialty pharmacy network. Specialty Pharmaceuticals are often high cost, typically greater than $600 for up to a 30-day supply. · Specialty Pharmaceuticals are not available through the retail or mail order option and are limited to a 30-day supply. Certain Specialty Pharmaceuticals may have additional day supply limitations. · Most Specialty Pharmaceuticals must be obtained through the Specialty Pharmaceutical network. For a complete list of these drugs, please see the Specialty Pharmaceutical listing at xxxx://xxxx.xxx.xxx/idc/groups/public/documents/communication/pel_00000000.pdf. You can call our Presbyterian Customer Service Center, Monday through Friday, from 7 a.m. to 6 p.m. at (000) 000-0000 or 0-000-000-0000. Hearing impaired users may call TTY 711.
Appears in 1 contract
Samples: Subscriber Agreement
Benefit Limitations. This benefit has one or more exclusions as specified in the Exclusions Section. You have the option to purchase up to a 90-day supply of Prescription Drugs/Medications. Under the up to a 90-day at Retail Pharmacy benefit, Preferred Generic, Non-Preferred Generic, Preferred Brand and Non-Preferred Drugs can be obtained from an In-network Pharmacy. If you choose the 90 days at retail option, you will be charged one Copayment copayment per 30-day supply up to a maximum of a 90-day supply. Some medications may qualify for third-party copayment assistance programs which could lower your out-of-pocket costs for those products. For any such medication where third-party copayment assistance is used (Discount Cards or Prescription Drug Savings Cards), the Member shall not will receive credit towards their maximum out-of-pocket or deductible for any copayment or coinsurance amounts that are applied to a manufacturer coupon or rebate. Self-Administered Specialty Pharmaceuticals Self-Administered Specialty Pharmaceuticals are self-administered, meaning they are administered by the patient, a family member or caregivercare-giver. Specialty Pharmaceuticals are often used to treat complex chronic, rare diseases and/or life-life- threatening conditions. Most Specialty Pharmaceuticals require Prior Authorization and must be obtained through the specialty pharmacy network. Specialty Pharmaceuticals are often high cost, typically greater than $600 for up to a 30-day supply. · Specialty Pharmaceuticals are not available through the retail or mail order option and are limited to a 30-day supply. Certain Specialty Pharmaceuticals may have additional day supply limitations. · Most Specialty Pharmaceuticals must be obtained through the Specialty Pharmaceutical specialty pharmacy network. For a complete list of these drugsdrugs and formulary coverage, please see the Specialty Pharmaceutical listing at xxxx://xxxx.xxx.xxx/idc/groups/public/documents/communication/pel_00000000.pdfxxxx://xxxx.xxx.xxx/idc/groups/public/documents/communication/pel_00236101.pdf. For Specialty Pharmacy information please see the pharmacy services available at xxxxx://xxx.xxx.xxx/doctors-services/services-centers/supporting- services/Pages/pharmacy-services.aspx. You can call our Presbyterian Customer Service CenterCenter for additional information about the Presbyterian Specialty Pharmacy network, Monday through Friday, Friday from 7 a.m. to 6 p.m. at (000) 000-0000 or 0-000-000-0000. Hearing impaired users may call TTY 711.
Appears in 1 contract
Samples: Presbyterian Health
Benefit Limitations. This benefit has one or more exclusions as specified in the Exclusions Section. You have the option to purchase up to a 90-day supply of Prescription Prescriptions Drugs/Medications. Under the up to a 90-day at Retail Pharmacy benefit, Preferred Generic, Non-Preferred Generic, Preferred Brand and Non-Preferred Drugs can be obtained from an In-network Pharmacy. If you choose the 90 days at retail option, you will be charged one Copayment copayment per 30-day supply up to a maximum of a 90-day supply. You will be charged three applicable Copayments for up to a 90-day supply up to the maximum dosing recommended by the manufacturer/FDA. • Some medications may qualify for third-party copayment assistance programs which could lower your out-of-pocket costs for those products. For any such medication where third-party copayment assistance is used (Discount Cards or Prescription Drug Savings Cards), the Member shall not receive credit towards toward their maximum out-of-pocket or deductible for any copayment or coinsurance amounts that are applied to a manufacturer coupon or rebate. rebate. Self-Administered Specialty Pharmaceuticals Self-Administered Specialty Pharmaceuticals are self-administered, meaning they are administered by the patient, a family member or caregiver. Specialty Pharmaceuticals are often used to treat complex chronic, rare diseases and/or life-threatening conditions. Most Specialty Pharmaceuticals require Prior Authorization and must be obtained through the specialty pharmacy network. Specialty Pharmaceuticals are often high cost, typically greater than $600 for up to a 30-day supply. · Specialty Pharmaceuticals are not available through the retail or mail order option and are limited to a 30-day supply. Certain Specialty Pharmaceuticals may have additional are limited to an initial fill up to a 15-day supply limitations. · Most Specialty Pharmaceuticals must be obtained through to ensure patients can tolerate the Specialty Pharmaceutical networknew medication. For a complete list of these drugs, please see the Specialty Pharmaceutical listing at xxxx://xxxx.xxx.xxx/idc/groups/public/documents/communication/pel_00000000.pdf. You can call our Presbyterian Customer Service Center, Monday through Friday, from 7 a.m. to 6 p.m. Center at (000) 000-0000 or 01-000800-000-0000. 923- 6980, Monday through Friday from 7 a.m. to 6 p.m. Hearing impaired users may call TTY 711.
Appears in 1 contract
Samples: Subscriber Agreement
Benefit Limitations. This benefit has one or more exclusions as specified in the Exclusions Section. You have the option to purchase up to a 90-day supply of Prescription Prescriptions Drugs/Medications. Under the up to a 90-day at Retail Pharmacy benefit, Preferred Generic, Non-Preferred Generic, Preferred Brand and Non-Preferred Drugs can be obtained from an In-network Pharmacy. If you choose the 90 90-days at retail option, you will be charged one Copayment copayment per 30-day supply up to a maximum of a 90-day supply. Some medications may qualify for third-party copayment assistance programs which could lower your out-of-pocket costs for those products. For any such medication where third-party copayment assistance is used (Discount Cards or Prescription Drug Savings Cards), the Member shall not receive credit towards toward their maximum out-of-pocket or deductible for any copayment or coinsurance amounts that are applied to a manufacturer coupon or rebate. Self-Administered Specialty Pharmaceuticals Self-Administered Specialty Pharmaceuticals are self-administered, meaning they are administered by the patient, a family member or caregiver. Specialty Pharmaceuticals are often used to treat complex chronic, rare diseases and/or life-threatening conditions. Most Specialty Pharmaceuticals require Prior Authorization and must be obtained through the specialty pharmacy network. Specialty Pharmaceuticals are often high cost, typically greater than $600 for up to a 30-day supply. · Specialty Pharmaceuticals are not available through the retail or mail order option and are limited to a 30-day supply. Certain Specialty Pharmaceuticals may have additional day supply limitations. · Most Specialty Pharmaceuticals must be obtained through the Specialty Pharmaceutical network. For a complete list of these drugs, please see the Specialty Pharmaceutical listing at at xxxx://xxxx.xxx.xxx/idc/groups/public/documents/communication/pel_00000000.pdf. You can call our Presbyterian Customer Service Center, Monday through Friday, from 7 a.m. to 6 p.m. Center at (000) 000-0000 or 01-000800- 923-000-0000. 6980, Monday through Friday from 7 a.m. to 6 p.m. Hearing impaired users may call TTY 711.
Appears in 1 contract
Samples: Group Subscriber Agreement
Benefit Limitations. This benefit has one or more exclusions as specified in the Exclusions Section. You have the option to purchase up to a 90-day supply of Prescription Drugs/Medications. Under the up to a 90-day at Retail Pharmacy benefit, Preferred Generic, Non-Preferred Generic, Preferred Brand and Non-Preferred Drugs can be obtained from an In-network Pharmacy. If you choose the 90 days at retail option, you will be charged one Copayment per 30-day supply up to a maximum of a 90-day supply. supply. Some medications may qualify for third-party copayment assistance programs which could lower your out-of-pocket costs for those products. For any such medication where third-party copayment assistance is used (Discount Cards or Prescription Drug Savings Cards), the Member shall not receive credit towards their maximum out-of-pocket or deductible for any copayment or coinsurance amounts that are applied to a manufacturer coupon or rebate. Self-Administered Specialty Pharmaceuticals Self-Administered Specialty Pharmaceuticals are self-administered, meaning they are administered by the patient, a family member or caregiver. Specialty Pharmaceuticals are often used to treat complex chronic, rare diseases and/or life-life- threatening conditions. Most Specialty Pharmaceuticals require Prior Authorization and must be obtained through the specialty pharmacy network. Specialty Pharmaceuticals are often high costcosts, typically greater than $600 for up to a 30-day supply. · Specialty Pharmaceuticals are not available through the retail or mail order option and are limited to a 30-day supply. Certain Specialty Pharmaceuticals may have additional day supply limitations. · Most Specialty Pharmaceuticals must be obtained through the Specialty Pharmaceutical network. For a complete list of these drugs, please see the Specialty Pharmaceutical listing at xxxx://xxxx.xxx.xxx/idc/groups/public/documents/communication/pel_00000000.pdfxxxx://xxxx.xxx.xxx/idc/groups/public/documents/communication/ pel_00000000.pdf. You can call contact our Presbyterian Customer Service Center, Monday through Friday, from 7 a.m. to 6 p.m. Center at (000) 000-0000 or 0-000-000-0000. , Monday through Friday from 7 a.m. to 6 p.m. Hearing impaired users may call TTY 711.
Appears in 1 contract
Samples: Presbyterian Health
Benefit Limitations. This benefit has one or more exclusions as specified in the Exclusions Section. You have the option to purchase up to a 90-day supply of Prescription Prescriptions Drugs/Medications. Under the up to a 90-day at Retail Pharmacy benefit, Preferred Generic, Non-Preferred Generic, Preferred Brand and Non-Preferred Drugs can be obtained from an In-network Pharmacy. If you choose the 90 90-days at retail option, you will be charged one Copayment copayment per 30-day supply up to a maximum of a 90-day supply. You will be charged three applicable Copayments for up to a 90-day supply up to the maximum dosing recommended by the manufacturer/FDA. • Some medications may qualify for third-party copayment assistance programs which could lower your out-of-pocket costs for those products. For any such medication where third-party copayment assistance is used (Discount Cards or Prescription Drug Savings Cards), the Member shall not receive credit towards toward their maximum out-of-pocket or deductible for any copayment or coinsurance amounts that are applied to a manufacturer coupon or rebate. Self-Administered Specialty Pharmaceuticals Self-Administered Specialty Pharmaceuticals are self-administered, meaning they are administered by the patient, a family member or caregiver. Specialty Pharmaceuticals are often used to treat complex chronic, rare diseases and/or life-threatening conditions. Most Specialty Pharmaceuticals require Prior Authorization and must be obtained through the specialty pharmacy network. Specialty Pharmaceuticals are often high cost, typically greater than $600 for up to a 30-day supply. · Specialty Pharmaceuticals are not available through the retail or mail order option and are limited to a 30-day supply. Certain Specialty Pharmaceuticals may have additional are limited to an initial fill up to a 14-day supply limitations. · Most Specialty Pharmaceuticals must be obtained through to ensure patients can tolerate the Specialty Pharmaceutical networknew medication. For a complete list of these drugs, please see the Specialty Pharmaceutical listing at xxxx://xxxx.xxx.xxx/idc/groups/public/documents/communication/pel_00000000.pdf. You can call our Presbyterian Customer Service Center, Monday through Friday, from 7 a.m. to 6 p.m. Center at (000) 000-0000 or 0-000-000-0000. , Monday through Friday from 7 a.m. to 6 p.m. Hearing impaired users may call our TTY line at 711.
Appears in 1 contract
Samples: Group Subscriber Agreement
Benefit Limitations. This benefit has one or more exclusions as specified in the Exclusions Section. You have the option to purchase up to a 90-day supply of Prescription Prescriptions Drugs/Medications. Under the up to a 90-day at Retail Pharmacy benefit, Preferred Generic, Non-Preferred Generic, Preferred Brand and Non-Preferred Drugs can be obtained from an In-network Pharmacy. If you choose the 90 days at retail option, you will be charged one Copayment copayment per 30-day supply up to a maximum of a 90-day supply. Some medications may qualify for third-party copayment assistance programs which could lower your out-of-pocket costs for those products. For any such medication where third-party copayment assistance is used (Discount Cards or Prescription Drug Savings Cards), the Member shall not receive credit towards toward their maximum out-of-pocket or deductible for any copayment or coinsurance amounts that are applied to a manufacturer coupon or rebate. Self-Administered Specialty Pharmaceuticals Self-Administered Specialty Pharmaceuticals are self-administered, meaning they are administered by the patient, a family member or caregiver. Specialty Pharmaceuticals are often used to treat complex chronic, rare diseases and/or life-threatening conditions. Most Specialty Pharmaceuticals require Prior Authorization and must be obtained through the specialty pharmacy network. Specialty Pharmaceuticals are often high cost, typically greater than $600 for up to a 30-day supply. · Specialty Pharmaceuticals are not available through the retail or mail order option and are limited to a 30-day supply. Certain Specialty Pharmaceuticals may have additional day supply limitations. · Most Specialty Pharmaceuticals must be obtained through the Specialty Pharmaceutical network. For a complete list of these drugs, please see the Specialty Pharmaceutical listing at xxxx://xxxx.xxx.xxx/idc/groups/public/documents/communication/pel_00000000.pdf. You can call our Presbyterian Customer Service Center, Monday through Friday, from 7 a.m. to 6 p.m. Center at (000) 000-0000 or 01-000800-000-0000. 923- 6980, Monday through Friday from 7 a.m. to 6 p.m. Hearing impaired users may call TTY 711.
Appears in 1 contract
Samples: Group Subscriber Agreement
Benefit Limitations. This benefit has one or more exclusions as specified in the Exclusions Section. You have the option to purchase up to a 90-day supply of Prescription Drugs/Medications. Under the up to a 90-day at Retail Pharmacy benefit, Preferred Generic, Non-Preferred Generic, Preferred Brand and Non-Preferred Drugs can be obtained from an In-network Pharmacy. If you choose the 90 90-days at retail option, you will be charged one Copayment per 30-day supply up to a maximum of a 90-day supply. You will be charged three applicable Copayments for up to a 90-day supply up to the maximum dosing recommended by the manufacturer/FDA. Some medications may qualify for third-party copayment assistance programs which could lower your out-of-pocket costs for those products. For any such medication where third-party copayment assistance is used (Discount Cards or Prescription Drug Savings Cards), the Member shall not receive credit towards their maximum out-of-pocket or deductible for any copayment or coinsurance amounts that are applied to a manufacturer coupon or rebate. Self-Administered Specialty Pharmaceuticals Pharmaceuticals Self-Administered Specialty Pharmaceuticals are self-administered, meaning they are administered by the patient, a family member or caregiver. Specialty Pharmaceuticals are often used to treat complex chronic, rare diseases and/or life-life- threatening conditions. Most Specialty Pharmaceuticals require Prior Authorization and must be obtained through the specialty pharmacy network. Specialty Pharmaceuticals are often high costcosts, typically greater than $600 for up to a 30-day supply. · Specialty Pharmaceuticals are not available through the retail or mail order option and are limited to a 30-day supply. Certain Specialty Pharmaceuticals may have additional are limited to an initial fill up to a 15-day supply limitations. · Most Specialty Pharmaceuticals must be obtained through to ensure patients can tolerate the Specialty Pharmaceutical networknew medication. For a complete list of these drugs, please see the Specialty Pharmaceutical listing at xxxx://xxxx.xxx.xxx/idc/groups/public/documents/communication/pel_00000000.pdfxxxx://xxxx.xxx.xxx/idc/groups/public/documents/ communication/pel_00000000.pdf. You can call contact our Presbyterian Customer Service Center, Monday through Friday, from 7 a.m. to 6 p.m. Center at (000) 000-0000 or 0-000-000-0000. , Monday through Friday, from 7 a.m. to 6 p.m. Hearing impaired users may call TTY 711.
Appears in 1 contract
Samples: Subscriber Agreement
Benefit Limitations. This benefit has one or more exclusions as specified in the Exclusions Section. You have the option to purchase up to a 90-day supply of Prescription Drugs/Medications. Under the up to a 90-day at Retail Pharmacy benefit, Preferred Generic, Non-Preferred Generic, Preferred Brand and Non-Preferred Drugs can be obtained from an In-In- network Pharmacy. If you choose the 90 days at retail option, you will be charged one Copayment copayment per 30-day supply up to a maximum of a 90-day supply. You will be charged three applicable Copayments for up to a 90-day supply up to the maximum dosing recommended by the manufacturer/FDA. Some medications may qualify for third-party copayment assistance programs which could lower your out-of-pocket costs for those products. For any such medication where third-party copayment assistance is used (Discount Cards or Prescription Drug Savings Cards), the Member shall not receive credit towards their maximum out-of-pocket or deductible for any copayment or coinsurance amounts that are applied to a manufacturer coupon or rebate. Self-Administered Specialty Pharmaceuticals Pharmaceuticals Self-Administered Specialty Pharmaceuticals are self-administered, meaning they are administered by the patient, a family member or caregiver. Specialty Pharmaceuticals are often used to treat complex chronic, rare diseases and/or life-threatening conditions. Most Specialty Pharmaceuticals require Prior Authorization and must be obtained through the specialty pharmacy network. Specialty Pharmaceuticals are often high cost, typically greater than $600 for up to a 30-day supply. · Specialty Pharmaceuticals are not available through the retail or mail order option and are limited to a 30-day supply. Certain Specialty Pharmaceuticals may have additional are limited to an initial fill up to a 15-day supply limitations. · Most Specialty Pharmaceuticals must be obtained through to ensure patients can tolerate the Specialty Pharmaceutical networknew medication. For a complete list of these drugs, please see the Specialty Pharmaceutical listing at xxxx://xxxx.xxx.xxx/idc/groups/public/documents/communication/pel_00000000.pdf. You can call contact our Presbyterian Customer Service Center, Monday through Friday, from 7 a.m. to 6 p.m. Center at (000) 000-0000 or 01-000800- 923-000-0000. 6980, Monday through Friday from 7 a.m. to 6 p.m. Hearing impaired users may call TTY 711.
Appears in 1 contract
Samples: Group Subscriber Agreement
Benefit Limitations. This benefit has one or more exclusions as specified in the Exclusions Section. You have the option to purchase up to a 90-day supply of Prescription Drugs/Medications. Under the up to a 90-day at Retail Pharmacy benefit, Preferred Generic, Non-Preferred Generic, Preferred Brand and Non-Preferred Drugs can be obtained from an In-network Pharmacy. If you choose the 90 90-days at retail option, you will be charged one Copayment per 30-day supply up to a maximum of a 90-day supply. You will be charged three applicable Copayments for up to a 90-day supply up to the maximum dosing recommended by the manufacturer/FDA. Some medications may qualify for third-party copayment assistance programs which could lower your out-of-pocket costs for those products. For any such medication where third-party copayment assistance is used (Discount Cards or Prescription Drug Savings Cards), the Member shall not receive credit towards their maximum out-of-pocket or deductible for any copayment or coinsurance amounts that are applied to a manufacturer coupon or rebate. Self-Administered Specialty Pharmaceuticals Self-Administered Specialty Pharmaceuticals are self-administered, meaning they are administered by the patient, a family member or caregiver. Specialty Pharmaceuticals are often used to treat complex chronic, rare diseases and/or life-life- threatening conditions. Most Specialty Pharmaceuticals require Prior Authorization and must be obtained through the specialty pharmacy network. Specialty Pharmaceuticals are often high costcosts, typically greater than $600 for up to a 30-day supply. · Specialty Pharmaceuticals are not available through the retail or mail order option and are limited to a 30-day supply. Certain Specialty Pharmaceuticals may have additional are limited to an initial fill up to a 14-day supply limitations. · Most Specialty Pharmaceuticals must be obtained through to ensure patients can tolerate the Specialty Pharmaceutical networknew medication. For a complete list of these drugs, please see the Specialty Pharmaceutical listing at xxxx://xxxx.xxx.xxx/idc/groups/public/documents/communication/pel_00000000.pdf. You can call contact our Presbyterian Customer Service Center, Monday through Friday, from 7 a.m. to 6 p.m. Center at (000) 000-0000 or 0-000-000-0000. , Monday through Friday from 7 a.m. to 6 p.m. Hearing impaired users may call our TTY line at 711.
Appears in 1 contract
Samples: Subscriber Agreement
Benefit Limitations. This benefit has one or more exclusions as specified in the Exclusions Section. You have the option to purchase up to a 90-day supply of Prescription Drugs/Medications. Under the up to a 90-day at Retail Pharmacy benefit, Preferred Generic, Non-Preferred Generic, Preferred Brand and Non-Preferred Drugs can be obtained from an In-network Pharmacy. If you choose the 90 days at retail option, you will be charged one Copayment per 30-day supply up to a maximum of a 90-day supply. supply. Some medications may qualify for third-party copayment assistance programs which could lower your out-of-pocket costs for those products. For any such medication where third-party copayment assistance is used (Discount Cards or Prescription Drug Savings Cards), the Member shall not receive credit towards their maximum out-of-pocket or deductible for any copayment or coinsurance amounts that are applied to a manufacturer coupon or rebate. Self-Administered Specialty Pharmaceuticals Self-Administered Specialty Pharmaceuticals are self-administered, meaning they are administered by the patient, a family member or caregiver. Specialty Pharmaceuticals are often used to treat complex chronic, rare diseases and/or life-life- threatening conditions. Most Specialty Pharmaceuticals require Prior Authorization and must be obtained through the specialty pharmacy network. Specialty Pharmaceuticals are often high costcosts, typically greater than $600 for up to a 30-day supply. · Specialty Pharmaceuticals are not available through the retail or mail order option and are limited to a 30-day supply. Certain Specialty Pharmaceuticals may have additional day supply limitations. · Most Specialty Pharmaceuticals must be obtained through the Specialty Pharmaceutical network. For a complete list of these drugs, please see the Specialty Pharmaceutical listing at xxxx://xxxx.xxx.xxx/idc/groups/public/documents/communication/pel_00000000.pdf. You can call contact our Presbyterian Customer Service Center, Monday through Friday, from 7 a.m. to 6 p.m. Center at (000) 000-0000 or 01-000800- 356-000-0000. 2219, Monday through Friday from7 a.m. to 6 p.m. Hearing impaired users may call TTY 711.
Appears in 1 contract
Samples: Presbyterian Health